LAMINECTOMY

The brain communicates with the body in the cranial nerves and the spinal nerves.

Laminectomy - Removal of part of the lamina.

Discectomy - Removal of part of an intervertebral disc.

In fact a partial discectomy.

Most common site - L5 - S1 then L4 - L5.

The Disc

Annulus fibrosus - outer ring of fibrous tissue

Nucleus Pulposus - central thick gelatinous material, changes with age.

Pathology

Annulus raptures, nucleus protrudes onto nerve root.

Investigations

Plain X.R.'s

C.T.

Bloods - exclude infection and myeloma.

History

Physical examination.

Mylogram - Use of light at heavy dye, head up for 24§, observe for meningeal irritation.

Treatment

Bed rest

Traction - 2/52

Physio

Corsets or plaster jacket

Pain control

Heat treatment

surgery.

Pre Op Care

Skin prep?

Venous bloods

Urine test

Rest and sleep on hard bed - spontaneous recovery, reduce local inflammation.

Psychological support - This will not CURE you, but will only relieve symptoms, you will still have a bad back.

Post Op

Lie flat 24-48§ with only one pillow

No monkey pole

Analgesia - pain should be less 1st day post op

Maintain spinal alignment - Log role from side to side with help, spinal bed?

4§ obs - ? infection

Observe for meningism and wound infection.

Check movement and sensation in legs i.e. in the nerve root area.

Sometimes wound drain - avoid cord compression.

THEN

Lie flat OR sit up

No back rest, not at a slant

Fully mobilise on 3rd day, within pain limits, then progressive

Home 1/52 if okay

Sutures - 10 days.

Patient Education

OPD Physio - back extension exercises

No lifting - then only correct lifting 3/12

No bending - work on posture

Recurrent is a REAL possibility

Examine home/work environment.

Avoid long journeys - flexion strain

Regular rest times

Use of heat eg., baths

Build up supporting muscles.